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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # %>'424 5W(-
ADDRESS 134"7 '4).,,L )~t~~1 L Z-"Zap
NAME OF MOBILE HOME PARK OR S/D !/mot ,i /I,'/(S 9 7
NAME OF OWNER (IFDIFFERENT) , d clack &
ADDRESS OF OWNER (IF DIFFERENT) ',576& t)lLrV,
PROPERTY LOCATION: STATE ROAD NAME AND # J;,-L1V6D ~tfc- r
PURPOSE OF INSPECTION: a ~ t - jl j C Z'
The aforementioned site has been evaluated byte Harnett oun y Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If this system should malfunction, the owner is responsible for
any necessary repairs.
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PART( ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
7-1-/1
ture of Environmental Health Specialist
Date